Opportunistic QCT Bone Mineral Density Measurements Predicting Osteoporotic Fractures: A Use Case in a Prospective Clinical Cohort
| Autor: | Claus Zimmer, Veronika A Koeppen-Ursic, Alexandra S. Gersing, Olga Gordijenko, Thomas Baum, Jan S. Kirschke, Yannik Leonhardt, Henrike Brandhorst, Pauline May, Vanadin Seifert-Klauss, Benedikt J. Schwaiger, Marcus R. Makowski |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine Endocrinology Diabetes and Metabolism Osteoporosis osteoporotic fracture Logistic regression lcsh:Diseases of the endocrine glands. Clinical endocrinology Endocrinology Absorptiometry Photon 0302 clinical medicine Bone Density Medicine Prospective Studies Quantitative computed tomography Original Research Aged 80 and over Bone mineral DXA fracture prediction Lumbar Vertebrae medicine.diagnostic_test Middle Aged Prognosis ddc Spinal Fractures Female musculoskeletal diseases Clinical cohort 030209 endocrinology & metabolism fracture liaison service Thoracic Vertebrae 03 medical and health sciences Humans Osteoporotic fracture Vertebral bone Aged lcsh:RC648-665 business.industry medicine.disease osteoporosis Logistic Models 030104 developmental biology Mineral density ROC Curve Tomography X-Ray Computed business Nuclear medicine bone mineral density QCT Osteoporotic Fractures Follow-Up Studies |
| Zdroj: | Frontiers in Endocrinology, Vol 11 (2020) Frontiers in Endocrinology |
| Popis: | Purpose To assess whether volumetric vertebral bone mineral density (BMD) measured with opportunistic quantitative computed tomography (QCT) (i.e., CT acquired for other reasons) can predict osteoporotic fracture occurrence in a prospective clinical cohort and how this performs in comparison to dual-energy X-ray absorptiometry (DXA) measurements. Methods In the database of our fracture liaison service, 58 patients (73 ± 11 years, 72% women) were identified that had at least one prevalent low-energy fracture and had undergone CT of the spine. BMD was determined by converting HU using scanner-specific conversion equations. Baseline DXA was available for 31 patients. During a 3-year follow-up, new fractures were diagnosed either by (i) recent in-house imaging or (ii) clinical follow-up with validated external reports. Associations were assessed using logistic regression models, and cut-off values were determined with ROC/Youden analyses. Results Within 3 years, 20 of 58 patients presented new low-energy fractures (34%). Mean QCT BMD of patients with fractures was significantly lower (56 ± 20 vs. 91 ± 38 mg/cm3; p = 0.003) and age was higher (77 ± 10 vs. 71 ± 11 years; p = 0.037). QCT BMD was significantly associated with the occurrence of new fractures, and the OR for developing a new fracture during follow-up was 1.034 (95% CI, 1.010-1.058, p = 0.005), suggesting 3% higher odds for every unit of BMD decrease (1 mg/cm3). Age and sex showed no association. For the differentiation between patients with and without new fractures, ROC showed an AUC of 0.76 and a Youden's Index of J = 0.48, suggesting an optimal cut-off value of 82 mg/cm3. DXA T-scores showed no significant association with fracture occurrence in analogous regression models. Conclusion In this use case, opportunistic BMD measurements attained through QCT predicted fractures during a 3-year follow-up. This suggests that opportunistic measurements are useful to reduce the diagnostic gap and evaluate the fracture risk in osteoporotic patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|